To Work or Not To Work? A Guide for Home Dialysis Patients

By DaVita® Social Worker Barbara Dickhaus, MSW, LICSW

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

“When you come to a fork in the road, take it,” Yogi Berra once said. If only big decisions were so simple.

You’ve already made the decision to dialyze at home. As your energy and well-being improve, you may find yourself facing another “fork in the road”: whether or not to go back to work. Here are some things to consider.

Where do I start?

• Your doctor. Ask your doctor about any limits you might have on the types of tasks you can perform because of your treatment. You might also ask if there are any limits on when you can return to work.
• A Work Incentive Planning and Assistance (WIPA) project. They can help you define your employment goals, including:
  • How work can affect your disability and healthcare benefits
  • Other aids in your job searc
  • Call 1-866-968-7842 to locate a WIPA project in your area.
• Other agencies.These may include:
  • State Department of Vocational Rehabilitation
  • Work source agencies
  • Job Corps
  • Employment agencies
  • State/federal personnel agencies
  • Guidance counselors at local schools and colleges

How will work affect my disability benefits?

Social Security has three programs for disability recipients who want to return to work:

• The Ticket to Work program. Free vocational rehabilitation, training and job referral; learn more at ChooseWorkTTW.net or call 1-866-968-9842.
• The Trial Work Period incentive program (for SSDI recipients only). This lets you keep receiving full cash benefits while working. Work period continues until you have worked nine trial work months within a 60-month period. A trial work month is any month where your income is greater than $720/month or, if self-employed, $720/month after expenses.
• An Extended Period of Eligibility. This starts after the Trial Work Period has ended. During this time you will receive full disability benefits for any month where your income is below what is considered “substantial” (approximately $1, 010/month for 2012).

Visit Social Security or call them at 1-800-772-1213 to learn about other programs for SSDI (Social Security Disability Income) and SSI (Supplemental Security Income) recipients.

Finally, disability benefits from a private source (pension and insurance benefits) will not affect your Social Security benefits. But disability payments from a public source (workman’s compensation, disability payments from local, state or federal programs) may affect benefits. Veteran’s Affairs (VA) benefits are excluded from this category.

What if I can’t keep working because of my disability?

Expedited Reinstatement is yet another program that allows for immediate reinstatement of your benefit if you find you’re unable to work again because of your disability. Reinstatement can occur for a period of five years after your cash benefits have stopped.

How will working affect my Medicare benefits?

If you become employed, your Medicare benefit continues for 93 months after the trial work period has ended.

If you want to keep getting Medicare after your disability benefits stop due to work, and you’re not yet at retirement age, then you’ll have the option to buy Medicare Part A. You must keep paying your Medicare Part B premiums.

Do I have to mention my kidney disease or treatment in a job interview?

You are not obligated to tell a prospective employer about your kidney disease. Also, the interviewer is not allowed to ask any questions about your medical status or whether you might need special accommodations to perform a role. If they offer you a job, then the employer can ask more specific questions about whether you need special accommodations. If you do, this is the time to discuss it.

Title 1 of the ADA (Americans with Disabilities Act of 1990) makes it unlawful for an employer with 15 or more employees to discriminate against a qualified applicant or employee with a disability. You must meet the qualifications for the job and be able to perform all required job functions independently or with the help of “reasonable accommodations” if needed. Employers are required to make “reasonable accommodations” unless such accommodations cause “undue hardship.”

More about the ADA and its requirements can be found at the EEOC (Equal Employment Opportunity Commission) website. The Rehabilitation Act of 1973 and 1993 prohibits discrimination by Federal Agencies. This act is enforced by the Department of Labor.

What are the benefits of working?

Going back to work can reward you with extra income, a bigger support network, and even a greater sense of purpose. This is only a brief outline of the many resources that are available to help you. Ask your social worker for more information on the resources available in your area.